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Thursday, May 29, 2014

Its abundantly clear that MERS-CoV transmission is fecal based (more on that in a follow on post). In that regard, one important but embarrassingly overlooked source for Camel to Human MERS-CoV transmission is the Bedouin practice of eating fresh steaming camel dung to treat dysentery.

Based on this connection, one might expect that most camel turds are consumed by people during the flood season when dysentery may be at its highest. Of course one might also assume that this treatment is most used when one is out in the desert and away from the cities. Tracking the epidemiological correlations may be telling in regards to MERS first appearance and subsequent peaks.

Now as nasty as Camel Coprophagia may seem, if you're dying in the middle of the desert and the obviously healthy native people tell you that you better chomp down of a fresh steaming camel turd if you want to stay alive, what do you do? Reportedly this is the exact situation the Nazi army in North Africa faced in WW2. The Nazis ended up placing fresh hot camel turd on the menu, and a few medical innovations followed.

Wednesday, May 28, 2014

A senior 'vaccine' scientist at US Navy's Naval Medical Research Unit (NAMRU) placed an order for a large amount of anti-MERS Polyclonal Antibodies produced by Sanford Applied Biosciences (SAB). This order no doubt will help SAB's bottom line with its hyper MERS infected trans-human cows, which produce such Polyclonal antibodies.

Given the cows are being infected with MERS-CoV, and given that its transmitted in feces, one hopes that these cows-human hybrids only poop in a bio-level 3 containment facility that doesn't compost its waste. We would not want to be down wind of those farmers fields.

If NAMRU's research on the Polyclonal treatments for MERS infections is successful, SAB may be in for a large windfall. Of course, it still remains to be seen if serum derived from trans-human cows will be considered halal or harram by MERS primary victims.

The Centers For Disease Control has released a flyer which threatens Airline pilots with legal action if they do not report ill travelers. The document specifies that both International and Interstate passengers must be reported if they are ill. Obviously this action is an indication that either a pandemic is underway or one is expected, and that air travel will be how the pandemic spreads. (STAY OUT OF AIRCRAFT RESTROOMS)

The obvious candidates for CDC's actions are MERS, EBOLA, H7N9 Bird Flu and H1N1 Swine Flu. Of these only EBOLA seems to be of any immediate (albeit fleeting) threat, and as such the Department of Defense has deployed EBOLA detection kits to National Guard units in all 50 states and to military units in South Korea.

Of the other threats, MERS and H7N9 are primarily adapted to their locations/cultures of origin/mass detection, and as such the threat of ongoing chain infection-transmission outside those locales/cultures seems low. Albeit, current MERS protocol involves quarantining all health care personnel who had initial contact with the infected person, meaning even a few cases could shut down the health care system. In regards to H1N1, the possibility of a more severe 2nd wave in the Fall should not be discounted.

Wednesday, May 21, 2014

Updated: 5/22/14
The local department of health says these are "two completely separate incidents" (see sources below), however a prudent risk posture would indicate exercising caution as if they were related.
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A confluence of two public health situations in Springfield Missouri involving MERS and Hepatitis-A have caught our attention.

This morning Missouri Public health authorities have reported at least two people in Springfield are being tested for MERS; This evening Missouri Public health authorities are asking around 5,000 people to come informedical evaluation related to a Hepatitis exposure at a Springfield Red Robin Restaurant.

The question of course is: are these two events related; and if they are, is such subterfuge permissible from a public health perspective? The safe course of action is to prepare as if they are related.

When we look at the MERS data we perceive a virus that is primarily transmitted through feces (as is Hepatitis-A). We also suspect that there is a minimum contamination level below which one might test positive for MERS-CoV via blood testing, but not develop the syndrome. Over all we perceive a low risk from MERS (with some cultural/religious based transmission exceptions); however we don't discount that our analysis might be incorrect (or that mutation could alter the risk).

The number one preventative is to avoid fecal contact. In that regard, we have a conjecture that MERS may be somewhat resistant to soap; through hand washing is important. The number one proactive measure is to wash with Hibiclens surgical scrub as it continues to kill enveloped virus for hours after having washed with it.

So, the question for Missouri Public Health is: Is the Hepatitis incident at Red Robin even remotely connected in ANY WAY to the possible MERS cases in Missouri? It would be wise to be prepared as if it does.

So the Department of Homeland Security has a contract out for 24 million rounds of .357 Sig ammunition, apparently they did not want to use the term "Hollowpoint" so they called it "Duty" ammunition instead. But obviously they did not specify "Training" ammunition, which normally is cheaper.

Outside of certain governmental organizations like the Federal Air Marshalls, and the Secret Service, .357 Sig ammo is not a vastly popular round. It is basically a .40 caliber case necked down to accept a 9mm bullet.

Who knows what it means, other than that a relatively small number of federal agents are expecting to do a whole hell of a lot of shooting, or they are expecting the ammo market to dry up for an extend period time; sorta like what happened during World War 2.

In that regard, healthcare workers helping their palliative MERS patients fulfill Quranic religious requirements would be at greater risk of MERS transmission. This risk would especially be the case in the Kingdom of Saudi Arabia where one would expect the utmost dedication to these practices; in the same regard Western healthcare workers with less physical contact would have less opportunity for transmission.

Of course given the religious aspects, it's not the type of infection vector which will be readily admitted too as some might consider it embarrassing. With that in mind, it is certainly much less embarrassing to blame transmission on an airborne route. However such a misdirection does nothing to solve the problem, even worse it serves to misdirect preventative resources. Rather than take embarrassment, the obvious solution is to increase infection control precautions for increased physical contact with patients.

Its important to note that feces and bathrooms were noted as a being a source for SARS-CoV spread, and that the CDC lists diarrhea as one of MERS-CoV's key symptoms. It is also important to note that in the Eastern world, where MERS is most prevalent, toilet hygiene is very different from the Western world. One key difference (as explained in the video below) which is likely to cause the spread of MERS-CoV is the Eastern method of using water and a bare hand to remove feces from the posterior.

The Eastern method of cleaning one's posterior of feces is prone to aerosolize CoV, and it also leads to direct contamination of the hand, which leads to CoV spread to surfaces via fomites. This vector may explain why CoV is seemingly readily being spread among health care workers in Saudi Arabia.

In that regard its plausible to assume that as MERS spreads from the Eastern world to the Western world, one is most likely to become infected in restrooms and food handling facilities. The obvious most dangerous common places for MERS-CoV infection would be Aircraft and Hospital restrooms.
Overall we see the deadly pandemic risk from MERS as being low, especially given that MERS has had at least two HAJJ cycles to spread across the world. HOWEVER when one combines poor hospital infection control and MERS tendency to infect and kill health care workers, it is possible that MERS-CoV could end up shutting down hospitals. The worst case scenario is an overlapping H7N9 and MERS-CoV outbreak. Edited to add that MERS is most likely to be spread Globally during the HAJJ cycle starting in October, which in turn means that Hospitals could be shutting down from MERS-CoV infections right as the Flu season starts to kick off.